Vascular stent with a mixed configuration of connectors

ABSTRACT

This invention provides for a radially expandable stent having superior strength and reduced foreshortening properties. The stents have a mixed configuration of straight and arcuate connector segments that serve to join annular segments that make up the body of the stent. Surprisingly the described mixed configuration provides superior resistance to flip deformation while maintaining desired flexibility.

This application is a U.S. Non-Provisional of U.S. ProvisionalApplication No. 61/837,553, filed Jun. 20, 2013, and is incorporatedherein by reference.

STATEMENT AS TO RIGHTS TO INVENTIONS MADE UNDER FEDERALLY SPONSOREDRESEARCH AND DEVELOPMENT

NOT APPLICABLE

REFERENCE TO A “SEQUENCE LISTING,” A TABLE, OR A COMPUTER PROGRAMLISTING APPENDIX SUBMITTED ON A COMPACT DISK

NOT APPLICABLE

FIELD OF THE INVENTION

This invention provides for a radially expandable stent having superiorstrength and reduced foreshortening properties. The stents have a mixedconfiguration of straight and arcuate connector segments that serve tojoin annular segments that make up the body of the stent. Surprisinglythe described mixed configuration provides superior resistance to flipdeformation while maintaining desired flexibility.

BACKGROUND OF THE INVENTION

This invention provides for a radially expandable stent having superiorstrength and reduced foreshortening properties. The stents have a mixedconfiguration of straight and arcuate connector segments that serve tojoin annular segments that make up the body of the stent. Surprisingly,the described mixed configuration with three links provides superiorresistance to flip deformation and longitudinal compression whilemaintaining desired flexibility.

BRIEF SUMMARY OF THE INVENTION

This invention provides for a radially expandable stent for insertioninto a body vessel having a tubular body with distal and proximal ends,the tubular body comprising: a plurality of annular segments defining alongitudinal axis where each annular segment has a substantially zig-zagshape forming a series of peaks and valleys wherein the plurality ofannular segments comprise a distal and a proximal annular end segmentrespectively defining the distal and proximal ends of the tubular bodyand at least two annular segments positioned internally between the twoend annular segments; and, a plurality of connector segments positionedparallel to the longitudinal axis and bridging the annular segmentswhere the connector segments between the end segments and theiradjoining internal segments are straight, are at least three in number,and at least 90% of the connector segments between the internal annularsegments are arcuate.

The stents may further comprise a configuration where the peaks andvalleys of the annular segments are 180° out of phase with the annularsegment adjacent to it such that the peaks of a first and a thirdannular segment extend toward a second annular segment positionedbetween the first and third segments and are aligned longitudinally withthe valleys of the second annular segment. Alternatively, the stents maybe configured such that the peaks and valleys of the annular segmentsare in phase with the annular segment adjacent to it such that the peaksof a first and a third annular segment extend toward a second annularsegment positioned between the first and third segments and are alignedlongitudinally with the peaks of the second annular segment.

Further, the stents of this invention may be configured such that theconnector segments between the distal annular end segment and the nexttwo internally positioned annular segments are straight.

It is preferred that the straight connector segments between annular endsegments and their adjoining annular internal segments are three innumber and they may optionally be positioned equidistant from each otheralong the circumference of the tubular body.

It is preferred that the stents described herein have a flip forcerequired to catastrophically deform the stent of greater than 0.2newtons.

The stents described herein may be formed of a metal tubular body suchas a cobalt chromium alloy.

The stents described herein may further comprise a drug-eluting coating.The coating may comprise rapamycin or a 40-O derivative of rapamycin.

In addition, this invention provides for a method of manufacturing aradially expandable stent for insertion into a body vessel having theabove-described configurations and properties.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1 (A-C) provides an overview of a cobalt chromium stent of thisinvention with three connector segments per annular ring. FIG. 1A is aflatten perspective. FIG. 1B is a circular perspective. FIG. 1C is ahead on perspective.

FIGS. 2 (A and B) provides an enlargement of the connectors in FIG. 1with FIG. 2A illustrating the straight connector and FIG. 1Billustrating the arcuate connector.

FIGS. 3 (a-c) provide an overview of the tensile tester adapted to testthe physical properties of the stents described herein. FIG. 2( a) isthe modified tensile tester. FIG. 2( b) is the needle prior to stentdeformation; and, FIG. 2( c) is after stent deformation.

DETAILED DESCRIPTION OF THE INVENTION

This invention provides an improved stent design that enhances a stent'sradial stiffness, decreases undesired foreshortening, and allows fornecessary longitudinal flexibility. The improvement being a mixedconfiguration of connectors linking stent segments. More particularly,the stents of this invention provide for improved mechanical strength ofstents and are solving the problem of stent distortion that can happenat either end of the stent during deployment. Stent distortions canhappen at both distal and proximal ends. When a stent is tracked throughthe arterial system it can encounter external obstacles, such aslesions, and there is a tendency for the crowns at either ends todistort or to flip. The resistance to flip is mainly dependent on thestent design and its material. Proximal end damage is especially commonafter the stent is expanded and the physician tries to cross the stentwith a guidewire or hits the stent with a guide catheter. Recovery of adistorted stent may require emergency surgery.

In addition, this invention provides for stents with improved radialstiffness. Radial stiffness is the effectiveness of the stent inresisting diameter loss due to vessel recoil and other mechanicalevents. Radial stiffness is defined as the hoop force per unit lengthrequired to elastically change stent diameter.

The stents of this invention also have less foreshortening than priorart stents with uniform configurations of connectors. Foreshorteningrefers to the fact that the expansion of the stent or its openingresults in geometric shortening of the stent. Foreshortening is definedas L−L_(load)/L where L is length pre load and L_(load) is length afterexpansion. Foreshortening can lead to large inaccuracies and is a knownissue in stent design. There are a number of solutions to this problem.See for example: U.S. Pat. No. 6,761,731 entitled, “Balloon-StentInteraction To Help Reduce Foreshortening” and US Pat. Publ. No.2003/0105517 entitled: “Non-foreshortening Stent.”

Mechanical Design

The stent bodies of this invention are made of a biocompatible material.These materials include cobalt chromium, nickel, magnesium, tantalum,titanium, stainless steel, nitinol, gold, platinum, inconel, iridium,silver, tungsten, and/or another biocompatible metal, or alloys of anyof these; carbon or carbon fiber; cellulose acetate, cellulose nitrate,silicone, polyethylene teraphthalate, polyurethane, polyamide,polyester, polyorthoester, polyanhydride, polyether sulfone,polycarbonate, polypropylene, high molecular weight polyethylene,polytetrafluoroethylene, or another biocompatible polymeric material, ormixtures or copolymers of these; poly-L-lactic acid, poly-DL-lacticacid, polyglycolic acid or copolymers thereof, a polyanhydride,polycaprolactone, polyhydroxybutyrate valerate or another biodegradablepolymer, or mixtures or copolymers of these; a protein, an extracellularmatrix component, collagen, fibrin or another biologic agent; or asuitable mixture of any of these.

In general, the stents of this invention include an expandable stentbody (1) formed of interconnected filaments. The filaments form radialsegments (2) joined to each other by connector segments or linkers (3).The connector segments or linkers (3) are straight or arcuate. Thestraight connector segments are placed between the end radial segments(2) defining the proximal and distal ends of the stents. The radialsegments (2) internal to the proximal and distal radial segments areconnected to each other by arcuate connector segments (3). The radialsegments (2) can have an expandable zig-zag, sawtooth, helical ribboncoil or sinusoidal wave structure, and the connector segments can be inline with each other or staggered.

The connector segments are generally between 0.1 mm and 0.5 mm. SeeFIGS. 1 and 2. The number and spacing of the connectors (3,4) affectsthe mechanical performance of the stent. There can be any number ofconnector segments between the radial segments (4); but, typically thereare between 2 and 6 evenly spaced around the radius of the stent. Theycan be in either an in line or in a staggered arrangement relative toeach other. Depending on the length and desired flexibility, thestraight connectors may be used between the first pair of annularsegments internal to the distal and proximal ends of the stent.

The contracted-state diameter of the stent is between approximately 0.5mm to 2.0 mm, preferably 0.71 to 1.65 mm, and a length of between 5 to100 mm. The expanded stent diameter is at least twice and up to 8-9times that of the stent in its contracted state, for example, a stentwith a contracted diameter of between 0.7 to 1.5 mm may expand radiallyto a selected expanded state of between 2.0 to 8.0 mm or more. Stentshaving this general stent-body architecture of linked, expandabletubular members are known, for example, as described in PCT PublicationNo. WO 99/07308, which is commonly owned with the present applicationand expressly incorporated by reference herein.

The dimensions of a stent will vary depending on the body lumen in whichthey are to be delivered. For example, a stent may have a diameterranging from approximately 0.5 mm to approximately 25.0 mm, and a lengththat ranges from approximately 4 mm to approximately 100 mm, 200 mm orlonger. Stents intended for use in coronary vasculature are typically1.5 mm to 6 mm in diameter, and from 5 mm to 60 mm long. Stents intendedfor peripheral vasculature can range from 1.5 mm to 12 mm in diameterand from 5 mm to 200 mm in length. An example of coronary stentmeasurements is described in co-owned U.S. Pat. No. 6,939,376, which iscommonly owned and expressly incorporated by reference herein.

Manufacture

The technological aspects for manufacturing stents of this invention arewell known and not critical to the understanding of implementation ofthe invention. In general terms, the stents are simply bodies withtubular envelopes having walls with openings. Three basic approaches areused to manufacture the stents. One can form the stent from a continuoustubular blank cut up into individual stents. The opening in the wallsforming the filaments formed by techniques such as laser cutting,photo-engraving, electron-discharge, machining, etc. Alternatively, thestents may be produced from a strip-like body in which the regions withopenings are formed, for example, by the techniques mentioned above,with a view to the subsequent closure of the strip-like element to forma tube, and lastly, the stents can be formed from a metal wire shaped bythe successive connection of loops of wire, for example, by means ofmicro-welding, brazing, gluing, crimping operations, etc.

The first solution described above is currently preferred for producingstents according to the embodiments described herein. In particular,laser-beam cutting has been found the most flexible solution with regardto the ability to form the recited characteristics of the stents.Commercially available stent laser cutting machines are available. Seefor example: TLS-HT1100 from THETA Kunshan Theta Micro Co, Ltd, PR Chinaand SCS 100 DH from Trotec located in Austria, Rofin (Germany).

For stents fabricated from Nitinol, the pattern of the stent andconnecting is programmed into a computer-guided laser cutter or lathe.The lathe cuts into a Nitinol tube into filaments of radial segments andconnecting segments in a manner which closely controls the outsidediameter and wall thickness of the stent. After the cutting step, thenitinol stent is progressively expanded until it reaches its fullyexpanded state. The expansion can be performed by an internal expansionfixture, although other expansion apparatus and methods can be used.Once expanded to its fully expanded state, the stent is heat-treated to“set” the shape memory of the Nitinol material to the fully expandeddimensions, then cleaned and electro-polished.

The stent is then compressed into a dimension which allows for deliveryinto a vessel, either through percutaneous delivery or through minimallyinvasive surgical procedures. Specifically, the stent is compressed intoa smaller state so that it can be delivered by a delivery device to thedesired location of the vessel. Any conventional delivery device couldbe used, such as but not limited to a tube, catheter, or sheath. Thecompression is accomplished at low temperatures and involves radial andlongitudinal compression to maintain the desired (same) length. Thiscompression is accomplished by cooling the stent 40 to a lowtemperature, for example, zero degrees Celcius, and while maintainingthis temperature, compressing the stent to allow the stent to beinserted inside the delivery device. Once inserted inside the deliverydevice, the stent is held by the delivery device in the compressed stateat room temperature.

A textured stent surface is often desired. See U.S. Pat. No. 6,805,898.In one embodiment, the method includes use of a mask to prevent at leasta portion of the stent from being abraded. Preferably, the mask is ahydrocarbon film, such as PARAFILM®, however, it will be appreciatedthat any suitable barrier to abrasion is suitable for use in thesemethods.

Accordingly, in a preferred embodiment, at least the luminal surface ofthe stent is not abraded or textured. In one embodiment, a sheet of themask approximately 5 mm by 60 mm is rolled around the diameter of amandrel such as a 1.4 mm glass capillary tube. The stent is positionedonto the mandrel and hand-crimped into the hydrocarbon mask. A stereomicroscope set between 10× and 40× may be used to ensure that theportion of the stent that is not to be abraded is covered by the mask.In a preferred embodiment, at least 80% of the stent wall thickness onall surfaces is masked by the hydrocarbon film layer. In one embodiment,the stent surface 5 is then treated by utilizing microblasting systems,such as the MICRO BLASTER® and PROCENTER® by Comco, Inc. or anequivalent.

In one embodiment, 25 μm of an abrasive, such as aluminum oxide, is usedto roughen the stent surface. The pressure is adjusted to 40 psi±5 psi,and a spray nozzle is positioned approximately 2.5 μm to 5.0 μm from thestent surface, making multiple passes over the stent. In anotherembodiment, the mask is removed by any appropriate means such as with asolvent or via ultrasonic cleaning.

Due to the roughening of the stent surface, different elements may beexpressed on the metal surface which can increase the susceptibility tocorrosion. As a result, the treated stent is generally passivatedaccording to 30 ASTM standards and cleaned in a series of solvents suchas chloroform, acetone, and/or isopropyl alcohol.

In another embodiment, the surface of the stent is uniformly abraded ina controlled manner via shot peening. Roughening of a stent surface isaccomplished using metal particles called shot that range in size fromapproximately 1 to 5 microns and is made from an atomic element havingat least a weight of 43 g/mol. For example, the shot may be in the formof particulate tantalum, particulate tungsten, particulate platinum,particulate iridium, particulate gold, particulate bismuth, particulatebarium.

A preferred texture is characterized by a surface roughness of at leastabout 20 μin (0.5 μm), and a surface roughness range of between about300-700 μin (7.5-17.5 μm). Carried on the roughened regions of the stentfilaments is a polymer-free coating of a limus drug having a coatingthickness greater than the range of surface roughness of the roughenedstent surface.

While certain methods of manufacture have been described above, it willbe appreciated by those skilled in the art that other methods ofmanufacture can be utilized without departing from the spirit and scopeof the present invention.

Drug Coatings

Stents of this invention may be coated with a polymer or with atherapeutic substance or with a polymer containing one or moretherapeutic substances known to one of ordinary skill in the art. One ormore therapeutic substances can be added to the stents of this inventionby dissolving or mixing the therapeutic substances in a solvent andapplying the therapeutic substance and solvent mixture to the surface ofthe stent. The coating may be abluminal or conformal.

In general, coating a stent with a polymer containing the therapeuticsubstance requires that a solution of the polymeric material and one ormore therapeutic substances are mixed, often with a solvent, and thepolymer mixture is applied to the stent. Examples of suitable firstsolvents include, but are not limited to, acetone, ethanol, methanol,isopropanol, tetrahydrofuran, and ethyl acetate.

The preferred polymers used for coatings are film-forming polymers thathave molecular weight high enough as to not be waxy or tacky. Thepolymers also must adhere to the stent and not be so readily deformableafter deposition on the stent as to be able to be displaced byhemodynamic stresses. The polymers' molecular weight must be high enoughto provide sufficient toughness so that the polymers will not to berubbed off during handling or deployment of the stent and must not crackduring expansion of the stent. The melting point of the polymer used inthe present invention should have a melting temperature of at least 40°C. and preferably above 50° C.

An implantable device may also be top coated with a polymer which doesnot contain a therapeutic substance, for example, to form a sealantlayer over an underlying layer, which does contain a therapeuticsubstance.

The polymer of choice depends on the desired rate of release or thedesired degree of polymer stability. The polymer used for coating may bebioabsorbable or biostable. A bioabsorbable polymer bio-degrades orbreaks down in the body and is not present sufficiently long afterimplantation to cause an adverse local response. Bioabsorbable polymersare gradually absorbed or eliminated by the body by hydrolysis,metabolic process, bulk, or surface erosion. A bioabsorbable polymer isoften preferred due to a reduction in the possibility of any chroniclocal response or separation of polymer from stent.

Examples of bioabsorbable, biodegradable materials include but are notlimited to: aliphatic polyesters, copoly(ether-esters), polyalkylenesoxalates, polyamides, poly(iminocarbonates), polyorthoesters,polyoxaesters, polyamidoesters, polyoxaesters containing amido groups,poly(anhydrides), polyphosphazenes, biomolecules and blends thereof.

Copoly(ether-esters) for the purpose of this invention include thosecopolyester-ethers described in Journal of Biomaterials Research, Vol.22, pages 993-1009, 1988 by Cohn and Younes and Cohn, Polymer Preprints(ACS Division of Polymer Chemistry) Vol. 30(1), page 498, 1989 (e.g.PEO/PLA).

Aliphatic polyesters include homopolymers and copolymers of lactide(which includes lactic acid d-, 1- and meso lactide), ε-caprolactone,glycolide (including glycolic acid), hydroxybutyrate, hydroxyvalerate,para-dioxanone, trimethylene carbonate (and its alkyl derivatives),1,4-dioxepan-2-one, 1,5-dioxepan-2-one, 6,6-dimethyl-1,4-dioxan-2-oneand polymer blends thereof.

Polyalkylene oxalates for the purpose of this invention include U.S.Pat. Nos. 4,208,511; 4,141,087; 4,130,639; 4,140,678; 4,105,034; and4,205,399 (incorporated by reference herein).

Polyphosphazenes, co-, ter- and higher order mixed monomer basedpolymers made from L-lactide, D,L-lactide, lactic acid, glycolide,glycolic acid, para-dioxanone, trimethylene carbonate and.epsilon.-caprolactone such as are described by Allcock in TheEncyclopedia of Polymer Science, Vol. 13, pages 31-41, WileyIntersciences, John Wiley & Sons, 1988 and by Vandorpe, Schacht,Dejardin and Lemmouchi in the Handbook of Biodegradable Polymers, editedby Domb, Kost and Wisemen, Hardwood Academic Press, 1997, pages 161-182(which are hereby incorporated by reference herein).

Poly(iminocarbonate) for the purpose of this invention include asdescribed by Kemnitzer and Kohn, in the Handbook of BiodegradablePolymers, edited by Domb, Kost and Wisemen, Hardwood Academic Press,1997, pages 251-272.

Polyanhydrides from diacids of the formHOOC—C₆H₄—O—(CH₂)_(m)—O—C₆H.₄—COOH where m is an integer in the range offrom 2 to 8 and copolymers thereof with aliphatic alpha-omega diacids ofup to 12 carbons.

Polyoxaesters, polyoxaamides and polyoxaesters containing amines and/oramido groups are described in a mini review by Andejelic et al., (2007)The Polyoxaesters in Polymer International 56(9):1063-1077 and in thefollowing U.S. Pat. Nos. 5,464,929; 5,595,751; 5,597,579; 5,607,687;5,618,552; 5,620,698; 5,645,850; 5,648,088; 5,698,213 and 5,700,583incorporated herein by reference.

Polyorthoesters of use in this invention are those described by Hellerin Handbook of Biodegradable Polymers, edited by Domb, Kost and Wisemen,Hardwood Academic Press, 1997, pages 99-118 (hereby incorporated hereinby reference).

Film-forming polymeric biomolecules for the purpose of this inventioninclude naturally occurring materials that may be enzymatically degradedin the human body or are hydrolytically unstable in the human body suchas fibrin, fibrinogen, collagen, elastin, heparin, and absorbablebiocompatable polysaccharides such as chitosan, starch, fatty acids (andesters thereof), glucoso-glycans and hyaluronic acid.

Preferred polymer coatings are polycaprolactone (PCL), poly-D, L-lacticacid (DL-PLA), poly-L-lactic acid (L-PLA), poly(lactide-co-glycolide),poly(hydroxybutyrate), poly(hydroxybutyrate-co-valerate), polydioxanone,polyorthoester, polyanhydride, poly(glycolic acid), poly(glycolicacid-cotrimethylene carbonate), polyphosphoester, polyphosphoesterurethane, poly(amino acids), cyanoacrylates, poly(trimethylenecarbonate), poly(iminocarbonate), copoly(ether-esters), polyalkyleneoxalates, polyphosphazenes, polyiminocarbonates, and aliphaticpolycarbonates.

The preferable coatings to use for this application are bioabsorbableelastomers, more preferably aliphatic polyester elastomers. In theproper proportions aliphatic polyester copolymers are elastomers.Elastomers present the advantage that they tend to adhere well to themetal stents and can withstand significant deformation without cracking.The high elongation and good adhesion provide superior performance toother polymer coatings when the coated stent is expanded.

The preferred bioabsorbable elastomeric polymers should have an inherentviscosity of from about 1.0 dL/g to about 4 dL/g, preferably an inherentviscosity of from about 1.0 dL/g to about 2 dL/g, and most preferably aninherent viscosity of from about 1.2 dL/g to about 2 dL/g as determinedat 25° C. in a 0.1 gram per deciliter (g/dL) solution of polymer inhexafluoroisopropanol (HFIP). Mixtures of the fast hydrolyzing and slowhydrolyzing polymers can be used to adjust the time of strengthretention.

More specifically, examples of suitable bioabsorbable elastomers aredescribed in U.S. Pat. No. 5,468,253 hereby incorporated by reference.Preferably the bioabsorbable biocompatible elastomers based on aliphaticpolyester, including but not limited to those selected from the groupconsisting of elastomeric copolymers of ε.-caprolactone and glycolide(preferably having a mole ratio of ε-caprolactone to glycolide of fromabout 35:65 to about 65:35, more preferably 45:55 to 35:65); elastomericcopolymers of .epsilon.-caprolactone and lactide, including L-lactide,D-lactide blends thereof or lactic acid copolymers (preferably having amole ratio of ε-caprolactone to lactide of from about 35:65 to about90:10, and more preferably from about 35:65 to about 65:35 and mostpreferably from about 45:55 to 30:70, or from about 90:10 to about80:20); elastomeric copolymers of p-dioxanone (1,4-dioxan-2-one) andlactide including L-lactide, D-lactide and lactic acid (preferablyhaving a mole ratio of p-dioxanone to lactide of from about 40:60 toabout 60:40); elastomeric copolymers of ε-caprolactone and p-dioxanone(preferably having a mole ratio of ε-caprolactone to p-dioxanone of fromabout 30:70 to about 70:30); elastomeric copolymers of p-dioxanone andtrimethylene carbonate (preferably having a mole ratio of p-dioxanone totrimethylene carbonate of from about 30:70 to about 70:30); elastomericcopolymers of trimethylene carbonate and glycolide (preferably having amole ratio of trimethylene carbonate to glycolide of from about 30:70 toabout 70:30); elastomeric copolymer of trimethylene carbonate andlactide including L-lactide, D-lactide, blends thereof or lactic acidcopolymers (preferably having a mole ratio of trimethylene carbonate tolactide of from about 30:70 to about 70:30) and blends thereof. As iswell known in the art, these aliphatic polyester copolymers havedifferent hydrolysis rates, therefore, the choice of elastomer may inpart be based on the requirements for the coatings adsorption.

Most preferred are homopolymers of poly D, L-lactic acid, andco-polymers of polylactic acid such as with polyglycolic acid orε-caprolactone.

Examples of biostable polymers include Parylene®, Parylast®,polyurethane (for example, segmented polyurethanes such as Biospan®)),polyethylene, polyethlyene terephthalate, ethylene vinyl acetate,silicone and polyethylene oxide.

Suitable film-forming biostable polymers with relatively low chronictissue response include polyurethanes, silicones, poly(meth)acrylates,polyesters, polyalkyl oxides (polyethylene oxide), polyvinyl alcohols,polyethylene glycols and polyvinyl pyrrolidone, as well as hydrogelssuch as those formed from crosslinked polyvinyl pyrrolidinone andpolyesters could also be used. Other polymers could also be used if theycan be dissolved, cured or polymerized on the stent. These includepolyolefins, polyisobutylene and ethylene-alphaolefin copolymers;acrylic polymers (including methacrylate) and copolymers, vinyl halidepolymers and copolymers, such as polyvinyl chloride; polyvinyl ethers,such as polyvinyl methyl ether; polyvinylidene halides such aspolyvinylidene fluoride and polyvinylidene chloride; polyacrylonitrile,polyvinyl ketones; polyvinyl aromatics such as polystyrene; polyvinylesters such as polyvinyl acetate; copolymers of vinyl monomers with eachother and olefins, such as etheylene-methyl methacrylate copolymers,acrylonitrile-styrene copolymers, ABS resins and ethylene-vinyl acetatecopolymers; polyamides, such as Nylon 66 and polycaprolactam; alkydresins; polycarbonates; polyoxymethylenes; polyimides; polyethers; epoxyresins, polyurethanes; rayon; rayon-triacetate; cellulose; celluloseacetate; cellulose acetate; butyrate; cellophane; cellulose nitrate;cellulose propionate; cellulose ethers (i.e. carboxymethyl cellulose andhydoxyalkyl celluloses); and combinations thereof. Polyamides for thepurpose of this application would also include polyamides of the form—NH—(CH₂)_(n)—CO— and NH—(CH₂)_(x)—NH—CO—(CH₂)_(y)—CO, wherein n ispreferably an integer in the range of from 6 to 13; x is an integer inthe range of from 6 to 12; and y is an integer in the range of from 4 to16. The list provided above is illustrative but not limiting.

Therapeutic Agents

Therapeutic substances can include, but are not limited to,antineoplastic, antimitotic, antiinflammatory, antiplatelet,anticoagulant, antifibrin, antithrombin, antiproliferative, antibiotic,antioxidant, and antiallergic substances as well as combinationsthereof.

Examples of such antineoplastics and/or antimitotics include paclitaxel(e.g., TAXOL® by Bristol-Myers Squibb Co., Stamford, Conn.); docetaxel(e.g., Taxotere® from Aventis S.A., Frankfurt, Germany); methotrexate;azathioprine; vincristine; vinblastine; fluorouracil; doxorubicinhydrochloride (e.g., Adriamycin® from Pharmacia & Upjohn, Peapack N.J.);and mitomycin (e.g., Mutamycin® from Bristol-Myers Squibb Co., Stamford,Conn.).

Examples of such antiplatelets, anticoagulants, antifibrin, andantithrombins include sodium heparin, low molecular weight heparins,heparinoids, hirudin, argatroban, forskolin, vapiprost, prostacyclin andprostacyclin analogues, dextran, D-phe-pro-arg-chloromethylketone(synthetic antithrombin), dipyridamole, glycoprotein IIb/IIIa plateletmembrane receptor antagonist antibody, recombinant hirudin, and thrombininhibitors such as Angiomax™ (Biogen, Inc., Cambridge, Mass.).

Examples of such cytostatic or antiproliferative agents includeangiopeptin, angiotensin converting enzyme inhibitors such as captopril(e.g., Capoten® and Capozide® from Bristol-Myers Squibb Co., Stamford,Conn.), cilazapril or lisinopril (e.g., Prinivil® and Prinzide® fromMerck & Co., Inc., Whitehouse Station, N.J.), calcium channel blockers(such as nifedipine), colchicine, fibroblast growth factor (FGF)antagonists, fish oil (omega 3-fatty acid), histamine antagonists,lovastatin (an inhibitor of HMG-CoA reductase, a cholesterol loweringdrug, brand name Mevacor® from Merck & Co., Inc., Whitehouse Station,N.J.), monoclonal antibodies (such as those specific forPlatelet-Derived Growth Factor (PDGF) receptors), nitroprusside,phosphodiesterase inhibitors, prostaglandin inhibitors, suramin,serotonin blockers, steroids, thioprotease inhibitors,triazolopyrimidine (a PDGF antagonist), and nitric oxide.

Additional antiproliferative/antimitotic agents including naturalproducts such as vinca alkaloids (i.e. vinblastine, vincristine, andvinorelbine), paclitaxel, epidipodophyllotoxins (i.e. etoposide,teniposide), antibiotics (dactinomycin (actinomycin D) daunorubicin,doxorubicin and idarubicin), anthracyclines, mitoxantrone, bleomycins,plicamycin (mithramycin) and mitomycin, enzymes (L-asparaginase whichsystemically metabolizes L-asparagine and deprives cells which don'thave the capacity to synthesize their own asparagine). Further,Antiproliferative/antimitotic alkylating agents such as nitrogenmustards (mechlorethamine, cyclophosphamide and analogs, melphalan,chlorambucil), ethylenimines and methylmelamines (hexamethylmelamine andthiotepa), alkyl sulfonates-busulfan, nirtosoureas (carmustine (BCNU)and analogs, streptozocin), trazenes-dacarbazinine (DTIC);antiproliferative/antimitotic antimetabolites such as folic acid analogs(methotrexate), pyrimidine analogs (fluorouracil, floxuridine, andcytarabine), purine analogs and related inhibitors (mercaptopurine,thioguanine, pentostatin and 2-chlorodeoxyadenosine {cladribine});platinum coordination complexes (cisplatin, carboplatin), procarbazine,hydroxyurea, mitotane, aminoglutethimide; hormones (i.e. estrogen).

Examples of anticoagulant drugs include heparin, synthetic heparin saltsand other inhibitors of thrombin.

Examples of fibrinolytic agents include tissue plasminogen activator,streptokinase and urokinase).

Examples of antiplatelet drugs include aspirin, dipyridamole,ticlopidine, clopidogrel, and abciximab.

Examples of anti-inflammatory drugs include those such as adrenocorticalsteroids (cortisol, cortisone, fludrocortisone, prednisone,prednisolone, 6.alpha.-methylprednisolone, triamcinolone, betamethasone,and dexamethasone), and non-steroidal agents (salicylic acidderivatives, i.e., aspirin; para-aminophenol derivatives, i.e.,acetominophen; Indole and indene acetic acids (indomethacin, sulindac,and etodalac), heteroaryl acetic acids (tolmetin, diclofenac, andketorolac), arylpropionic acids (ibuprofen and derivatives), anthranilicacids (mefenamic acid, and meclofenamic acid), enolic acids (piroxicam,tenoxicam, phenylbutazone, and oxyphenthatrazone), nabumetone, goldcompounds (auranofin, aurothioglucose, gold sodium thiomalate);immunosuppressive: (cyclosporine, tacrolimus (FK-506), sirolimus(rapamycin), azathioprine, mycophenolate mofetil).

In other examples, the therapeutic substance is a radioactive isotopefor implantable device usage in radiotherapeutic procedures. Examples ofradioactive isotopes include, but are not limited to, phosphoric acid(H₃P³²O₄), palladium (Pd¹⁰³), cesium (Cs¹³¹), and iodine (I¹²⁵). Whilethe preventative and treatment properties of the foregoing therapeuticsubstances or agents are well-known to those of ordinary skill in theart, the substances or agents are provided by way of example and are notmeant to be limiting. Other therapeutic substances are equallyapplicable for use with the disclosed methods and compositions.

Preferred therapeutic substances are rapamycin derivatives. Mostpreferred is 42-O-(2-ethoxyethyl) rapamycin (BA9); everolimus andsirolimus.

Methods of applying the therapeutic substance or polymer, or combinationof the two, are known to those of skill in the art. Methods include, butare not limited to hand application using a brush, computerized coatingdevices that directly apply coating from a feed system, physicalimmersion, spray-coating, sputtering, and gas-phase polymerization.

The solvent is chosen such that there is the proper balance ofviscosity, deposition level of the polymer, solubility of thepharmaceutical agent, wetting of the stent, and evaporation rate of thesolvent to properly coat the stents. In the preferred embodiment, thesolvent is chosen such that the pharmaceutical agent and the polymer areboth soluble in the solvent. In some cases, the solvent must be chosensuch that the coating polymer is soluble in the solvent and such thatpharmaceutical agent is dispersed in the polymer solution in thesolvent. In that case, the solvent chosen must be able to suspend smallparticles of the pharmaceutical agent without causing them to aggregateor agglomerate into collections of particles that would clog the slotsof the stent when applied. Although the goal is to dry the solventcompletely from the coating during processing, it is a great advantagefor the solvent to be non-toxic, non-carcinogenic and environmentallybenign. Mixed solvent systems can also be used to control viscosity andevaporation rates. In all cases, the solvent must not react with orinactivate the pharmaceutical agent or react with the coating polymer.Preferred solvents include but are not limited to: acetone,N-methylpyrrolidone (NMP), dimethyl sulfoxide (DMSO), toluene, methylenechloride, chloroform, 1,1,2-trichloroethane (TCE), various freons,dioxane, ethyl acetate, tetrahydrofuran (THF), dimethylformamide (DMF),and dimethylacetamide (DMAC).

The film-forming biocompatible polymer coatings are generally applied toreduce local turbulence in blood flow through the stent, as well as,adverse tissue reactions. The coating may also be used to administer apharmaceutically active material to the site of the stents placement.Generally, the amount of polymer coating to be placed on the stent willvary with the polymer and the stent design and the desired effect of thecoating. As a guideline, the amount of coating may range from about 0.5to about 20 as a percent of the total weight of the stent after coatingand preferably will range from about 1 to about 15 percent. The polymercoatings may be applied in one or more coating steps depending on theamount of polymer to be applied. Different polymers may also be used fordifferent layers in the stent coating. In fact, it is highlyadvantageous to use a dilute first coating solution as primer to promoteadhesion of subsequent coating layers that may contain pharmaceuticallyactive materials.

Additionally, a top coating can be applied to delay release of thepharmaceutical agent, or used as the matrix for the delivery of adifferent pharmaceutically active material. The amount of top coatingson the stent may vary but will generally be less than about 2000 μg,preferably the amount of top coating will be in the range of about 10 μgto about 1700 μg, and most preferably in the range of from about 300 μgto about 1600 μg. Layering of coating of fast and slow hydrolyzingcopolymers can be used to stage release the drug or to control releaseof different agents placed in different layers. Polymer blends may alsobe used to control the release rate of different agents or to providedesirable balance of coating (i.e., elasticity, toughness, etc.) anddrug delivery characteristics (release profile). Polymers with differentsolubilities in solvents can be used to build up different polymerlayers that may be used to deliver different drugs or control therelease profile of a drug. For example, ε-caprolactone-co-lactideelastomers are soluble in ethyl acetate and ε-caprolactone-co-glycolideelastomers are not soluble in ethyl acetate. A first layer ofε-caprolactone-co-glycolide elastomer containing a drug can be overcoated with ε-caprolactone-co-glycolide elastomer using a coatingsolution made with ethyl acetate as the solvent. Additionally, differentmonomer ratios within a copolymer, polymer structure, or molecularweights may result in different solubilities. For example, 45/55ε-caprolactone-co-glycolide at room temperature is soluble in acetone,whereas a similar molecular weight copolymer of 35/65ε-caprolactone-co-glycolide is substantially insoluble within a 4 weightpercent solution. The second coating (or multiple additional coatings)can be used as a top coating to delay the drug delivery of the drugcontained in the first layer. Alternatively, the second layer couldcontain a different drug to provide for sequential drug delivery.Multiple layers of different drugs could be provided by alternatinglayers of first one polymer then the other. As will be readilyappreciated by those skilled in the art, numerous layering approachescan be used to provide the desired drug delivery.

Coating may be formulated by mixing one or more therapeutic agents withthe coating polymers in a coating mixture. The therapeutic agent may bepresent as a liquid, a finely divided solid, or any other appropriatephysical form. Optionally, the mixture may include one or moreadditives, e.g., nontoxic auxiliary substances such as diluents,carriers, excipients, stabilizers or the like. Other suitable additivesmay be formulated with the polymer and pharmaceutically active agent orcompound. For example, hydrophilic polymers selected from the previouslydescribed lists of biocompatible film forming polymers may be added to abiocompatible hydrophobic coating to modify the release profile (or ahydrophobic polymer may be added to a hydrophilic coating to modify therelease profile). One example would be adding a hydrophilic polymerselected from the group consisting of polyethylene oxide, polyvinylpyrrolidone, polyethylene glycol, carboxylmethyl cellulose,hydroxymethyl cellulose and combination thereof, to an aliphaticpolyester coating to modify the release profile. Appropriate relativeamounts can be determined by monitoring the in vitro and/or in vivorelease profiles for the therapeutic agents.

The best conditions for the coating application are when the polymer andpharmaceutical agent have a common solvent. This provides a wet coatingthat is a true solution. Less desirable, yet still usable, are coatingsthat contain the pharmaceutical as a solid dispersion in a solution ofthe polymer in solvent. Under the dispersion conditions, care must betaken to ensure that the particle size of the dispersed pharmaceuticalpowder, both the primary powder size and its aggregates andagglomerates, is small enough not to cause an irregular coating surfaceor to clog the slots of the stent that we need to keep coating-free. Incases where a dispersion is applied to the stent and we want to improvethe smoothness of the coating surface or ensure that all particles ofthe drug are fully encapsulated in the polymer, or in cases where we maywant to slow the release rate of the drug, deposited either fromdispersion or solution, we can apply a clear (polymer only) top coat ofthe same polymer used to provide sustained release of the drug oranother polymer that further restricts the diffusion of the drug out ofthe coating. The top coat can be applied by dip coating with mandrel aspreviously described or by spray coating (loss of coating during sprayapplication is less problematic for the clear topcoat since the costlydrug is not included). Dip coating of the top coat can be problematic ifthe drug is more soluble in the coating solvent than the polymer and theclear coating redissolves previously deposited drug. The time spent inthe dip bath may need to be limited so that the drug is not extractedout into the drug-free bath. Drying should be rapid so that thepreviously deposited drug does not completely diffuse into the topcoat.

The amount of therapeutic agent will be dependent upon the particulardrug employed and medical condition being treated. Typically, the amountof drug represents about 0.001% to about 70%, more typically about0.001% to about 60%, most typically about 0.001% to about 45% by weightof the coating.

The quantity and type of polymers employed in the coating layercontaining the pharmaceutical agent will vary depending on the releaseprofile desired and the amount of drug employed. The product may containblends of the same or different polymers having different molecularweights to provide the desired release profile or consistency to a givenformulation.

Absorbable polymers upon contact with body fluids including blood or thelike, undergoes gradual degradation (mainly through hydrolysis) withconcomitant release of the dispersed drug for a sustained or extendedperiod (as compared to the release from an isotonic saline solution).Nonabsorbable and absorbable polymers may release dispersed drug bydiffusion. This can result in prolonged delivery (over, say 1 to 2,000hours, preferably 2 to 800 hours) of effective amounts (say, 0.001μg/cm²-min to 100 .mu.g/cm²-min) of the drug. The dosage can be tailoredto the subject being treated, the severity of the affliction, thejudgment of the prescribing physician, and the like.

Individual formulations of drugs and polymers may be tested inappropriate in vitro and in vivo models to achieve the desired drugrelease profiles. For example, a drug could be formulated with a polymer(or blend), coated on a stent, and placed in an agitated or circulatingfluid system (such as PBS 4% bovine albumin). Samples of the circulatingfluid could be taken to determine the release profile (such as by HPLC).The release of a pharmaceutical compound from a stent coating into theinterior wall of a lumen could be modeled in an appropriate porcinesystem. The drug release profile could then be monitored by appropriatemeans such as by taking samples at specific times and assaying thesamples for drug concentration (using HPLC to detect drugconcentration). Thrombus formation can be modeled in animal models usingthe ¹¹¹In-platelet imaging methods described by Hanson and Harker, Proc.Natl. Acad. Sci. USA 85:3184-3188 (1988). Following this or similarprocedures, those skilled in the art will be able to formulate a varietyof stent coating formulations.

Deployment

The stent of this invention can be deployed by a number of deliverysystems and delivery methods. These delivery systems and methods willvary depending on whether the stent is expanded by self-expansion orradial expansion forces. The methods of the invention are designed tominimize the risk and/or extent of restenosis in a patient who hasreceived localized vascular injury, or who is at risk of vascularocclusion due to the presence of advanced atherosclerotic disease.

Typically the vascular injury is produced during an angiographicprocedure to open a partially occluded vessel, such as a coronary orperipheral vascular artery. Alternately, the stent may be introducedinto a site of vascular narrowing and expanded using the balloon todirectly open up the narrowed portion of the vessel (i.e., the vascularinjury disease site). In the first mentioned angiographic procedure, aballoon catheter is first placed at the occlusion site, and a distal-endballoon is inflated and deflated one or more times to force the occludedvessel open. This vessel expansion, particularly involving surfacetrauma at the vessel wall where plaque may be dislodged, often producesenough localized injury that the vessel responds over time by cellproliferation and reocclusion in the vicinity of the implanted stent.Not surprisingly, the occurrence or severity of restenosis is oftenrelated to the extent of vessel stretching involved in the angioplastyprocedure.

The present invention is intended to be used without limitations to anyparticular method of therapeutically treating a vascular site, and canbe used with either of the techniques described above, or withalternative techniques for vascular disease and injury as is known. Inpracticing the present invention, the stent is placed in its contractedstate typically at the distal end of a catheter, either within thecatheter lumen, or in a contracted state on a distal end balloon. Thedistal catheter end is then guided to the injury site, or to the site ofpotential occlusion, and released from the catheter, e.g., by pullingback a sheath covering the stent to release the stent into the site, ifthe stent is self-expanding, or by expanding the stent on a balloon byballoon inflation, until the stent contacts the vessel walls, in effect,implanting the stent into the tissue wall at the site.

To better view the stent as it travels along the patient's vasculature,radiopaque materials may be included onto or into the stent. Thesematerials include but are not limited to, materials comprising iodine oriodine-derivatives, such as; for example, iohexyl and iopamidol, whichare detectable by x-rays.

All publications and patent applications cited in this specification areherein incorporated by reference as if each individual publication orpatent application were specifically and individually indicated to beincorporated by reference.

Although the foregoing invention has been described in some detail byway of illustration and example for purposes of clarity ofunderstanding, it will be readily apparent to those of ordinary skill inthe art in light of the teachings of this invention that certain changesand modifications may be made thereto without departing from the spiritor scope of the appended claims.

Examples Example 1 Fabrication of the New Stent

A stent is fabricated from cobalt-chromium alloy (MP35N). It islaser-cut from cobalt-chromium tubings whose ID varies from 1.2 mm to1.8 mm. In order to accommodate a wide range of expansion diameters, thestent has either 6 or 9 crowns. The 6-crown stent (SV) can be expandedup to 3.0 mm, and the 9-crown stent (MV) can be expanded up to 4.0 mm,the length of the stent can vary from 9.5 mm to 36.5 mm. Each pattern iscomprised of a series of corrugated rings aligned along a commonlongitudinal axis. Each ring is connected to the adjacent ring by threelinks/connectors aligned in the longitudinal direction (see FIG. 1). Theunique feature of this stent is that the end links are straight, whilethe rest of the links are serpentine.

Example 2 A Description of the Flip Force Measurement and Comparisonwith Stent with Uniform Connectors

A new test method was developed to evaluate the resistance to flippingof different stent designs. FIGS. 3 a-c depict the test fixture and testmethod. The stent was crimped onto a mandrel with the end crown of thestent sticking out from the mandrel. It was placed on a tensile testerand a needle (5) attached to a force gauge was positioned over theexposed crown of the stent. The force required to displace the crown agiven distance was used to compare the flip force of the differentdesigns.

It was discovered that the resistance to flipping, and hence,longitudinal distortion, was considerably improved by replacing the ends-links with straight links. The Table below shows the results from thetwo design iterations. Also, since most of the connectors are stills-links, stent flexibility and tracking was not sacrificed. An increaseof 52% in flip/distortion strength was obtained using a stent of Example1 compared to a stent with three s-shaped connector segments linking theterminal annular segment with an adjacent internal annular segment. SeeTable 1.

TABLE 1 Average Flip force Design Rev (N) Flip force with s-link at theend (Rev 13 0.150 results) Flip with straight link at the ends (Rev 160.228 results)

Example 3 Minimizing Foreshortening of Stents

Stents tend to foreshorten when expanded from crimped (small diameter)state to larger diameter. The ends of the stents expand first and canpush the links inwards in the axial direction—causing stentforeshortening. The problem is exacerbated as stents became moreflexible with less axial strength. During the development of the stentof this invention, one unexpected finding was that foreshortening wasconsiderably reduced by incorporating straight links at the end bandsand increasing the number of end-links from two to three. The resultsbelow show that by combining triple links with straight links at theend, foreshortening can be reduced several folds. See Table 2.

TABLE 2 Max foreshortening for Design Rev 9.5 mm stent (%) 2 body linkwith peak-to-valley design (Rev 16 13.70 results) 3 body link withpeak-to-peak design (Rev 19 3.35 results)

Example 4 Minimizing Longitudinal Compression of Stents

In addition to foreshortening, longitudinal compression is becoming anincreasing issue as stent's become thinner. Longitudinal compression isa distortion that arises when guidewires, catheters and balloons getcaught on the edge (proximal to the patient) of the stent duringwithdrawal procedures or during subsequent interventions.

During the development of the stent of this invention, one unexpectedfinding was that foreshortening was considerably reduced byincorporating straight links at the end bands. The three straight linksresisted deformation during stent expansion and prevented the inners-links from also collapsing/shortening. The results in Table 1 belowwere obtained using expanded stents (3 mm) on a mandral of 2.6 mmdiameter. A force of 0.5 newtons was applied to the stents using adonut-shaped component with a lumen of 2.65 mm in a material testingdevice from Instron (Norwood, Mass.). The Table below compares thelongitudinal strength of Element (2 connectors) vs. our currentBiomatrix Flex (2 connectors) and with the ‘mixed connector design’ ofthis invention. The mixed connector (with 3-link) configuration of thisinvention gave surprisingly superior resistance to longitudinalcompression over the other tested.

Stent Model Longitudinal Crush (3.0 × 19 mm) (%) BioMatrix Flex 28.6Mixed connector (2-link) 19.2 Mixed connector (3-link) 3.0 Xience V 12.9Promus Element 33.8 Resolute Integrity 17.7

While the description above refers to particular embodiments of thepresent invention, it will be understood that many modifications may bemade without departing from the spirit thereof. The accompanying claimsare intended to cover such modifications as would fall within the truescope and spirit of the present invention.

What is claimed is:
 1. A radially expandable stent for insertion into abody vessel having a tubular body having a circumference, a distal endand a proximal end wherein the tubular body comprises: a plurality ofannular segments defining a longitudinal axis where each annular segmenthas a substantially zig-zag shape forming a series of peaks and valleyswherein the plurality of annular segments comprise a distal and aproximal annular end segment respectively defining the distal andproximal ends of the tubular body and at least two annular segmentspositioned internally between the two end annular segments; and, aplurality of connector segments positioned parallel to the longitudinalaxis and bridging the annular segments where the connector segmentsbetween the annular end segments and their adjoining annular internalsegments are straight, are at least three in number, and at least 90% ofthe connector segments between the internal annular segments arearcuate.
 2. The stent of claim 1 wherein the peaks and valleys of theannular segments are 180° out of phase with the annular segment adjacentto it such that the peaks of a first and a third annular segment extendtoward a second annular segment positioned between the first and thirdsegments and are aligned longitudinally with the valleys of the secondannular segment.
 3. The stent of claim 1 wherein the straight connectorsegments between annular end segments and their adjoining annularinternal segments are three.
 4. The stent of claim 1 wherein thestraight connector segments between annular end segments and theiradjoining annular internal segments are positioned equidistant from eachother along the circumference of the tubular body.
 5. The stent of claim3 wherein the straight connector segments between annular end segmentsand their adjoining annular internal segments are positioned equidistantfrom each other along the circumference of the tubular body.
 6. Thestent of claim 1 wherein the peaks and valleys of the annular segmentsare in phase with the annular segment adjacent to it such that the peaksof a first and a third annular segment extend toward a second annularsegment positioned between the first and third segments and are alignedlongitudinally with the peaks of the second annular segment.
 7. Thestent of claim 1 wherein the connector segments between the distalannular end segment and the next two internally positioned annularsegments are straight.
 8. The stent of claim 1 wherein the flip forcerequired to catastrophically deform the stent is greater than 0.2newtons.
 9. The stent of claim 1 where the tubular body is a metal. 10.The stent of claim 1 where the metal is a cobalt chromium alloy.
 11. Thestent of claim 1 further comprising a drug eluting coating.
 12. Thestent of claim 11 comprising rapamycin or a 40-O derivative ofrapamycin.
 13. The stent of claim 1 wherein the stent has dimensions forsupporting a coronary artery.
 14. The stent of claim 1 wherein the stenthas dimensions for supporting a peripheral artery.
 15. A method ofmanufacturing a radially expandable stent for insertion into a bodyvessel where the stent has a tubular body with a circumference, a distalend and a proximal end, the method comprising: forming the tubular bodyof the stent to have a plurality of annular segments defining alongitudinal axis where each annular segment has a substantially zig-zagshape forming a series of peaks and valleys wherein the plurality ofannular segments comprise a distal and a proximal annular end segmentrespectively defining the distal and proximal ends of the tubular bodyand at least two annular segments positioned internally between the twoend annular segments; and, a plurality of connector segments positionedparallel to the longitudinal axis and bridging the annular segmentswhere the connector segments between the end segments and theiradjoining internal segments are straight, are at least three in number,and at least 90% of the connector segments between the internal annularsegments are arcuate.
 16. The method of claim 15 wherein the peaks andvalleys of the annular segments are 180° out of phase with the annularsegment adjacent to it such that the peaks of a first and a thirdannular segment extend toward a second annular segment positionedbetween the first and third segments and are aligned longitudinally withthe valleys of the second annular segment.
 17. The method of claim 15wherein the straight connector segments between annular end segments andtheir adjoining annular internal segments are three.
 18. The method ofclaim 15 wherein the straight connector segments between annular endsegments and their adjoining annular internal segments are positionedequidistant from each other along the circumference of the tubular body.19. The method of claim 15 wherein the straight connector segmentsbetween annular end segments and their adjoining annular internalsegments are positioned equidistant from each other along thecircumference of the tubular body.
 20. The method of claim 15 whereinthe peaks and valleys of the annular segments are in phase with theannular segment adjacent to it such that the peaks of a first and athird annular segment extend toward a second annular segment positionedbetween the first and third segments and are aligned longitudinally withthe peaks of the second annular segment.
 21. The method of claim 15wherein the connector segments between the distal annular end segmentand the next two internally positioned annular segments are straight.22. The method of claim 15 wherein the flip force required tocatastrophically deform the stent is greater than 0.2 newtons.
 23. Themethod of claim 15 where the tubular body is a metal.
 24. The method ofclaim 13 where the metal is a cobalt chromium alloy.
 25. The method ofclaim 15 further comprising a drug eluting coating.
 26. The method ofclaim 15 comprising rapamycin or a 40-O derivative of rapamycin.